Tricare updates Tele-Health billing procedures
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[The following applies for certain to Tricare West, and may or may not apply to other Tricare programs such as Tricare East.]
Tricare now requires billing of Tele-Health Place-of-Service to be from where the CLINICIAN performs the service if you would have seen them in-person - until the COVID emergency declaration ends.
If you are performing a telehealth session at your office or home-office, use the "11-Office" POS with a modifier in the 1st box of "95" or "GT" (all mental health codes can be either and since TriWest also requires an 11/95 for mental health telehealth services it may be easier to use that.)
This does mean that all Telehealth claims will need to be modified real quick (pick the POS 11) because it's defaulted to an "02-Telehealth" in the claim (unless you default your telehealth office to "11" which is easiest and then no modification is needed!)
An "11" will pay about 10% more than an "02."
Don't forget that modifiers can be set to populate automatically in new appointments using the "Client Default Services" at the bottom of their "Billing and Insurance" page and also can be entered into the little boxes below the service line in any added appointment.
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Hi,
Tricare East uses Humana. Here's a page [ https://www.humanamilitary.com/provider/education-and-resources/quick-access/telemedicine ] that leads to this document: [ https://docushare-web.apps.cf.humana.com/Marketing/docushare-app?file=3924427 ].
How do I bill for telemedicine services?
Please refer provider to policy for applicable CPT codes.
Synchronous* telemedicine services will use CPT or HCPCS codes with a GT modifier for distant site and Q3014 for an applicable originating site to distinguish telemedicine services. Also, Place of Service “POS 02” is to be reported in conjunction with the GT modifier.
Asynchronous* telemedicine services will use CPT or HCPCS codes with a GQ modifier.
When submitting claims for telemedicine services, the provider may indicate “Signature not required-distance telemedicine site” in the required patient signature field.
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Hi Mei,
That original statement is for what I use, which is Tricare West. I don't use Tricare East, but was merely pointing you in the right direction to bill appropriately. I should have put Tricare West in the original post. Sorry.
However, I did just find this: https://manuals.health.mil/pages/DisplayManualHtmlFile/2021-03-26/AsOf/tp15/c7s22_1.html
- 2.3.2.4 For billing asynchronous telemedicine services, providers will use CPT or HCPCS codes with a GQ modifier. In addition, POS 02 is to be reported in conjunction with the GQ modifier. Place of Service Code 02 is not required for telehealth claims if a more appropriate Place of Service Code is necessary for correct billing.
This does not mean the Humana can/will process it this way. The original above of 11/95 was how Tricare West got us "correct" billing (full reimbursement rate instead of reduced telehealth reimbursement rate). Humana may be getting you full reimbursement rate already.The reimbursements right now (may adjust slightly for service area, etc. - if you're not off by at least 10%-12% it's probably not a POS/Modifier billing issue) are:90837 - $119.6199354 - $102.0990791 - $142.22
If your reimbursements are significantly lower than this, I'd try one claim at 11/95, and another one at 11/GT and see if they even process at all, and - if so - what they pay. If it's higher, to get the higher rate on all old claims you would have to resubmit them with the new POS/Modifier combo (which is actually very easy to do in S/P - it takes 30 seconds).
Best of luck!The same info is also on a COVID-specific release [TRICARE Coverage and Payment for Certain Services in Response to the Coronavirus 2019 (COVID-19) Pandemic] for temporary exception to the prohibition on telephone services in the United States with an effective date of May 12, 2020:- 2.1.3 Other authorized telephone services (e.g., psychotherapy services) shall be reported with the appropriate CPT or HCPCS code and with the appropriate modifier or place of service code (e.g., 02) to report that the care was delivered via telephone. Place of Service Code 02 is not required for telehealth claims if a more appropriate Place of Service Code is necessary for correct billing.
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Hi Mei,
A very late update, but we just started processing with TRICARE East, and our "02/GT" paid the same full rate as an "11" or an "11/95."
This means if you primarily bill TRICARE EAST, you can set your "Telehealth Office" to default to PoS "02", AND default those clients individually to a "GT" modifier for each session, and won't need to do any editing of their claims at all.
This DOES NOT apply to TRICARE West nor TriWest. To get "full rate" for a telehealth session that would have been in the office but for COVID, it still needs an "11/95" (PoS of "11 - Office" and modifier of "95").
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This means if you primarily bill TRICARE EAST, you can set your "Telehealth Office"...
Another inadequate response from support! This software is supposed to be working for us, not the other way around. The problem is I don't PRIMARILY use one insurance I have a lot of Tricare AND BCBS patients. I shouldn't have to change the facility code back and forth. We've been ASKING FOR WHAT A YEAR? LONGER? for a "Write Off" button on the patient's billing page. STILL HAVENT GOTTEN IT, so I'm not optimistic about this but: "Where we set the default service code for each, providers should be able to edit the location (POS) as well.
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